Practice Changes in Glycemic Management and Outcomes in Coronary Artery Bypass Surgery Patients

Autor: Lori Pennell, Brent Hamar, Joanne Westerfield, Cecilia M. Smith-Snyder, Laurel R. Hudson
Rok vydání: 2005
Předmět:
Adult
Blood Glucose
Male
medicine.medical_specialty
medicine.medical_treatment
Population
Nurse's Role
Perioperative Care
Coronary artery bypass surgery
Diabetes mellitus
Outcome Assessment
Health Care
medicine
Humans
Hypoglycemic Agents
Insulin
Nurse Practitioners
Prediabetes
Coronary Artery Bypass
Practice Patterns
Physicians'
Intensive care medicine
education
Aged
Retrospective Studies
Cardiac catheterization
Aged
80 and over
Advanced and Specialized Nursing
education.field_of_study
business.industry
Blood Glucose Self-Monitoring
Perioperative
Length of Stay
Middle Aged
medicine.disease
Impaired fasting glucose
Organizational Innovation
Cardiac surgery
Nursing Evaluation Research
Hyperglycemia
Practice Guidelines as Topic
Emergency medicine
Female
Cardiology and Cardiovascular Medicine
business
Total Quality Management
Zdroj: The Journal of Cardiovascular Nursing. 20:26-34
ISSN: 0889-4655
Popis: This study aims to evaluate whether a quality improvement initiative in hyperglycemia management could result in substantiated practice changes and improved outcomes for coronary artery bypass surgery patients. Retrospective chart review and analysis of 103 randomly selected patients hospitalized for coronary artery bypass surgery was used. After the glycemia awareness initiative, the perioperative use of intravenous insulin infusion therapy increased in the total population (P = .01) as well as in the diabetes population (P = .03). Frequency of blood glucose level tests ordered for nondiabetic patients increased from 2.8 per day to 4.3 per day (P = .38). Blood glucose values improved in the diabetic population (Ps = .02, .048). The average length of stay improved in all nondiabetic patients (10.7-8.1 days, P = .07) including those who had coronary artery bypass graft surgery with cardiac catheterization (7.8-6.2 days, P = .09) and coronary artery bypass graft surgery with catheterization with complications (15.0-9.0 days, P = .12). The glycemia awareness initiative resulted in a positive impact on practice patterns. Undiagnosed diabetes and impaired fasting glucose are important and unrecognized issues within this hospital population. It is recommended that healthcare practitioners assume that cardiac patients have an increased likelihood of impaired fasting glucose and hyperglycemia. Advanced practice nurses can improve patient outcomes by ordering glucose testing and glycemic management as a routine practice for all cardiac surgery patients, regardless of diabetes diagnosis. Cardiac staff nurses can recommend glucose testing and screening for prediabetes and diabetes as a routine part of all nursing assessment.
Databáze: OpenAIRE
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